401k Plan data: FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN plan

FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN 401k Plan overview

Plan Name	FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN
Plan identification number	001

FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

FIVE STAR ASSISTED LIVING SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name: FIVE STAR ASSISTED LIVING SERVICES, LLC

Employer identification number (EIN): 204892575

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2009-01-01 KIM BURKE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2009-01-01	KIM BURKE

Plan Statistics for FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN

401k plan membership statisitcs for FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN

Measure Date Value
2009: FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 424
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 357
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 210
Total of all active and inactive participants 2009-01-01 568
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 568
Number of participants with account balances 2009-01-01 478
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 146

Measure	Date	Value
2009: FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	424
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	357
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	210
Total of all active and inactive participants	2009-01-01	568
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	568
Number of participants with account balances	2009-01-01	478
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	146

Financial Data on FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN

Measure	Date	Value
2009 : FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN

2009: FIVE STAR ASSISTED LIVING SERVICES 401(K) & PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	FIVE STAR ASSISTED LIVING SERVICES, LLC
Employer identification number (EIN):	204892575